CASE REPORT

A 73-year-old woman had had symptoms of intermittent blurring of vision in the right eye for several months and had consulted her optometrist, who had reassured her. She subsequently presented to her general practitioner with a 3 month history of left upper arm and right lower chest ‘rib’ pain, anorexia, weight loss, malaise, and fatigue. Skeletal survey revealed multiple extrapleural lesions bilaterally, with associated lytic bone destruction at each site. There was also evidence of lysis of the transverse process of T1 and facet complex of C7 on the right. She was referred urgently for further investigation.

On admission examination revealed no focal neurological deficit and investigation revealed hypercalcaemia (corrected calcium 2.80 mmol/l), raised serum protein (89 g/l), raised plasma viscosity (2.08 mPa), a venous IgG type κ paraprotein of 40 g/l, and …